Billing code 78451: Cardiac SPECTMedicare rate & RVUs in Virginia
Reports one SPECT myocardial perfusion study at rest or stress to assess blood flow to the heart muscle in suspected or known coronary disease.
Medicare pays $305.85–$360.90 for 78451 in the office in Virginia, from Virginia to Dc + Md/Va Suburbs. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 78451 covers
This service uses a radiopharmaceutical and a gamma camera to create tomographic images of myocardial perfusion for one study, performed at rest or under exercise or pharmacologic stress. Cardiologists, nuclear medicine physicians, and radiologists may interpret the images in hospital or outpatient imaging settings. Clinicians commonly use the study to evaluate suspected or established coronary artery disease and possible ischemia or prior myocardial injury.
Report 78451 for a single rest or stress study; when both rest and stress studies are performed, 78452 is the related SPECT code. Documentation should identify the study condition and support the imaging and interpretation performed. The code has professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies equipment and staff, and no component modifier represents the global service. The cardiovascular diagnostic multiple procedure reduction applies to the technical component.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 78451 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | $360.90 | Unavailable |
| Virginia | $305.85 | Unavailable |
How the 78451 rate is calculated
Each of 78451’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 78451
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.35Practice expense 7.87Malpractice 0.10
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78451
The CMS indicators that decide how 78451 is paid alongside other services.
CMS payment indicators · 78451
Cardiac SPECT
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 6 | Diagnostic cardiovascular reduction applies to the technical component. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
78451 without 26 · national office
$311.30
Cardiac SPECT
78451-26 · Professional component
$63.13
Pays only the interpretation and report.
78451 compared with similar codes
Compare codes
78451 vs 78452 vs 78453 vs 78454 vs 78491: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78452Nuclear stress test
- Both describe myocardial perfusion SPECT. Choose 78451 for one rest or stress study; 78452 represents multiple studies, commonly rest and stress.
- 78453Heart perfusion imaging
- 78453 describes a single myocardial perfusion study using planar imaging. 78451 is for tomographic SPECT imaging.
- 78454Heart imaging
- 78454 is the multiple-study planar myocardial perfusion code. 78451 is tomographic SPECT for a single study.
- 78491Myocrd img pet 1std rst/strs
- 78491 is myocardial perfusion imaging with PET. Use 78451 when the modality performed is SPECT.
78451 billing questions
When is 78451 reported instead of 78452?
Use 78451 for one SPECT myocardial perfusion study at rest or stress. When the service includes both rest and stress studies, compare the documentation with 78452.
Does one study mean one image or one view?
No. The distinction is the number of myocardial perfusion studies, not the number of image slices or views. Document whether the single study was performed at rest or stress.
How should the professional and technical work be billed?
Use modifier 26 for the physician's interpretation and modifier TC for the equipment and staff. Report the global service without either component modifier when one claim includes both portions.
Can the technical component be reduced when other tests are performed?
The cardiovascular diagnostic multiple procedure reduction applies to the technical component of 78451. It does not change the professional component under the CMS rule provided.
What documentation supports 78451?
Document that myocardial perfusion SPECT was performed, whether the single study was at rest or stress, and the physician's interpretation. For stress imaging, identify the stress method used.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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